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Hematopoietic colony-stimulating factor priming does not influence survival in acute myeloid leukemia: a meta-analysis of randomized trials

Leukemia volume 23, pages 811–813 (2009)Cite this article

Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage CSF are hematopoietic CSFs that stimulate proliferation, differentiation and activation of myeloid progenitor cells.1 CSFs have primarily been used following completion of chemotherapy with the objective of reducing the duration of neutropenia. Although prophylactic CSFs can reduce infection outcomes, they do not appear to impact overall survival.2 In addition to the prophylactic setting, CSFs also have been used in patients with acute myeloid leukemia (AML), with the aim of improving outcome by enhancing response to chemotherapy. In this setting, CSFs are administered before or concurrent with chemotherapy to increase the susceptibility of malignant cells to chemotherapy. This use of CSF has been referred to as CSF priming.3

Several randomized controlled trials of CSF priming have been conducted in patients with AML. A relatively large study by the Dutch–Belgian Hemato-Oncology cooperative group found that G-CSF administered concurrently with chemotherapy improved disease-free survival (42 vs 33%; P=0.02) in all patients and significantly improved overall survival in standard risk patients with AML.4 However, these positive results were tempered by several trials that did not demonstrate a benefit associated with CSF priming, thus leading to uncertainty regarding the usefulness of this intervention. We hypothesized that synthesizing the data from all randomized trials may provide a comprehensive determination of the potential efficacy of CSF priming. This information could then be used to determine whether this intervention merits further study or should be used routinely in clinical practice. In this meta-analysis, the primary objective was to determine if CSF priming is associated with improved overall survival compared with placebo or no therapy in AML patients. The secondary objectives were to determine if CSF priming improves disease-free survival, event-free survival, remission rates and relapse risk. We also looked for specific effects of CSF priming in predefined clinically relevant subgroups.

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Acknowledgements

LS is supported by a career development award with the Canadian Child Health Clinician Scientist Training Program, a strategic program with the Canadian Institutes of Health Research. SMHA is a Research Scientist of the National Cancer Institute of Canada. JB would like to acknowledge funding from the Canadian Institute of Health Research.

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Authors and Affiliations

  1. Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada

    L Sung

  2. Department of Paediatrics, Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada

    L Sung, J Beyene & R Almeida

  3. Department of Medicine, University Health Network, Toronto, Ontario, Canada

    S M H Alibhai

  4. Department of Hematology-Oncology, Children's Mercy Hospitals and Clinics, Kansas City, MO, USA

    A Gamis

  5. Department of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA

    S Smith & R Aplenc

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  1. L Sung
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  2. S M H Alibhai
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  3. J Beyene
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  4. A Gamis
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  5. R Almeida
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  6. S Smith
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  7. R Aplenc
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Correspondence to L Sung.

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Supplementary Information accompanies the paper on the Leukemia website (http://www.nature.com/leu)

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Sung, L., Alibhai, S., Beyene, J. et al. Hematopoietic colony-stimulating factor priming does not influence survival in acute myeloid leukemia: a meta-analysis of randomized trials. Leukemia 23, 811–813 (2009). https://doi.org/10.1038/leu.2008.305

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